Attention-deficit hyperactivity disorder(ADHD) is one of the most common disorder occurring in childhood. Historically, the nomenclature has emphasized the essential features quite differently, with labels ranging from presumed etiology of the disorder(minimal brain dysfunction) to some salient features(hyperactivity or attention-deficit). In clinical practice, ADHD is diagnosable by age 36 months, but can be very hard to identify before five years. Thus, identification is often delayed until elementary school, where demands for physical stillness are greater, comparison to peers is easier, and there is more group stimulation. The most frequent outcome of childhood ADHD is clinical normalcy but residual symptoms such as restlessness and fidgeting can be observed in adults, and some may become antisocial personality disorder in adulthood, ADHD may be associated with other psychiatric disorders, such as conduct disorders, de-pressive disorders or Tourette's disorder. Particularly, one subtype of ADHD may be genetically linked to Tourette's disorder Epidemiological studies show that boys predominate girls by times, and the over-all clinical symptom seem to be milder in girls than in boys. It seems clear that ADHD results from a large variety of etiologies and that various syndromes share a common final pathway of behavioral hyperactivity and attention. Future research should be focused on the elucidation of the etiologies and ADHD should be subclassified based on the various etiologies.

The neural mechanisms involved in attention deficit hyperactivity disorder are largely unknown. In order to investigate the neuroanatomical lesions of attention deficit hyperactivity disorders and their relationships with psychopathology, Single Photon Emission Computed Tomography(SPECT) using HMPAO was performed in 46 ADHDS and Yale Children's Inventory(YCI), Conners Parent Questionaire and DSM-III-R Questionaire for Disruptive Behavior Disorder were used to assess the psychopathology of ADHDS The results are summarized as follows; 1) 30.4% (14/46) of this series revealed decreased perfusion In SPECT. 2) Regions of hypoperfusion were seen in cerebral cortex(17.4%, 8/46), thalamus(13.0%, 6/46), deep gray matter(8.7%, 4/46), basal ganglia(6.5%, 3/46) and cerebellum(2.2%, 1/ 46). 3) The mean scores of the total YCI revealed significant difference between the two groups(SPECT abnormal versus normal group), and among the subscales, hyperactivity, language and fine-motor subscales showed significant differences between the two groups. Although the relationship between the abnormal findings and specific symptom clusters of ADHDS remains unclear, we can suggest that these abnormal findings could be associated with ADHD, and based on these findings, the ADHDS can be subclassified into two groups. This study can be said to reinforce the current conception of heterogeneity of ADHD.

The author studied EEG differences among normal, children, children with emotional behavioral problems determined by Rutter's questionnaire and children with attention-deficit hyperactivity disorder according to DSM-III-R. The results are as follows ; There were no differences in incidence and pattern of abnormal EEG between normal control children and children with emotional behavioral problems. But children with attention-deficit hyperactivity disorder tend to show lower average amplitude, and less wave percentage time of alpha wave in occipital area than normal did, furdermore wave percentage time of alpha wave appeared more in left occipital area than in right occipital area, These results demonstrated that emotional behavioral problems in elementary school children may not be related to EEG abnormality, Where as children with attention deficit hyperactivity disorder showed underdeveloped alpha waves as compared with normal control children.

The purpose of the present study is to investigate cognitive characteristics of ADHD children by comparing their performances on KEDI-WISC according to age and EEG variables. Subjects were 56 ADHD children who visited Seoul National University Children's Hospital during the period from January, 1988 to March, 1989. Group differences on age and EEG variables were tested by ANOVA, and Hierarchical Cluster Analysis was performed to investigate how ADHD children were classified based on their performances on KEDI-WISC. The results Indicated that ADHD children showed low scores on Coding, Digit Span, and Comprehension subtests, suggesting their attention deficits and impulsivity. ADHD children were clustered Into three groups based on only FSIQ. In post-hoc tests three groups showed different cognitive strengths and weaknesses on KEDI-WISC. Group differences on age were not significant, and abnormal EEG group showed lower PIQ than normal EEG group, suggesting the possibility that their attention deficits were related to neurological factors.

Behavioral characteristics of Attention Deficit Hyperactivity Disorder (ADHD) are aften observed in normal children. As a result, it is at times difficult to distinguish behavior disorder of clinical significance and normal developmental phenomenon. In addition, symptoms of ADHD can vary greatly depending on situations and social context, creating considerable difficulties in assessment. Therefore it is important to obtain information from various sources and in diverse situations. It is also desirable to quantify the severity of the problems whenever possible and determine their clinical significance by comparing the data to developmental norms. Specifically, various assessment methods such as interview with parent and child, behavior rating scales, behavioral observation and psychological testing were reviewed with discussion on merits and limitatious of each. It was emphasized that systematic and comprehensive assessment utilizing appropriate methods is necessary for accurate diagnosis and treatment evaluation of ADHD.

Management of the child with Attention-Deficit Hyperativity Disorder(ADHD) reguires a comprehensive approach of cognitive-behavioral, educational, and pharmacological interventions. Establishing the valid diagnosis is the first step of management. After the diagnosis is made, the clinician must then interpret the diagnosis and its impliations to the child, parents, and teachers. The pharmacotherapy is most effeceive, and the CNS stimulants (methylphenidate) is drug of choice. Although generally not as effective as stimulants, triacyclic antidepressants, clonidine, antipsychotics offer the alternatives to stimulants therapy. Additional treatments, including psychotherapy, cogntive-behavioral approach, educational infervention, parental counseling are also essential in managing the child with ADHD. Finally, controversial approaches-diet therapy, mineral therapy, hypoglycemia, megavitamin therapy, refined sugars, neurophysiological retraining approaches are reviewed.

60 Attention-deficit hyperactive patients treated with stimulant drugs such as methylphenidate and pemoline were evaluated in regards to the therapeutic benefit and side effects of these drugs. The results were as follows : 1) Of the 60 subjects 34 showed considerable imporvement and only 8 showed little or no improvement. 2) Hyperactivity, inattention and impulsivity were improved markedly by stimulants These behavioral changes were accompanied by improved performance in classroom. 3) School age children tended to show more improvement than preschool children or adolescence. 4) Of the 60 subjects 25 showed no side effect and only 6 showed severe side effects, and common side effects were decreased appetite, insomnia and irritability or nervousness. It is the author's impression that despite of the therapeutic efficacy of these drugs when they were administered on a short-term basis, long-term outcome dose not seem to be altered by the administration of these agents.

The survey of emotional behavioral problems in elementary school children provide baseline data for understanding, treating and preventing emotional behavioral problems in children. Since children can show different behaviors at home and at school, parents' information alone can lead to underestimate severity and prevalence rate of emotional behavioral problems in children. Thus, the author investigated the different the pattern of emotional behavioral problems in elementary school children by various socio-enviornmental factors in urban(Seoul) and rural area, by employing both parents' and teachers' questionnaire. The results were as follows ; Analysis of Rotter's questionnaire, in which high scores mean more serious emotional behavioral problems than low scores. The mean total problems scores for rural elementary school children were higher than those of Seoul elementary school children, and boys showed higher scores than girls. In relation to grade, mena total problems scores diminished as grade increased up to 4th or 5th, and then relatively high score for the 6th grade. Parent's education had significant effect on the total problem scores, that children of less educated parents showed higher score than children of more educated parents. Likewise the highest score was observed in children of unemployed parents. These results demonstrated that emotional behavioral children are related to various socio-environment factors.

Child Psychiatric consultations on 92 patients hospitalized at the Seoul National Childrens Hospistal were analyzed retrospectively. The main referral sources were Pedictrics(77.2%), Neurosurgery(8.91%) and Orthopedics(3.96%) Consultation rate was 0.81% for the Hospital, 1.41% for Department of Pediatrics, 3.54% for Neurosurgery and 0.3% for the other department were made for the differential diagnosis raher than for the treatment or intervention. The diagnosis of referred patients were somatoform disorder(25%), organic mental disorder(18.5%), developmental disorder(14.1), conduct disorder(6.5%), anxiety disorder(6.5%).

35 children(17 boys, 18 girls) with Recurrent Abdominal pain(RAP) without apparent organic causes, referrd from pediatric department of Seoul National University Children's Hospital were studied during 1988. 7. 1 1989. 2. 28. The aims of this study are to examine clinical characteristics of the patients with RAP, to find possible factors influencing the onset and the course of the disorder, to evaluate the psychological status and the relationship with psychiatric diagnoses. The study subjects were compared with the age and sex matched control subjects on measures of social and school functioning, family-environment, behavior traits by CBCL and parent-environment rating scale. All patients and their mothers were interviewed by a child psychiatrist. The results were as follows ; 1) Abdominal pain was found to be more frequent when with a care taker, and related with traumatic life stresses such as separation from parents, death of family members. 2) Family members of the patients with RAP also had a high rate of a history of gastrointestinal dysfunctions with could not be attributed to organic etiologies. 3) Among 35 patients with RAP, 16 were diagnosed as psychiatric disorders. They were adjustment disorders (4), overanxious disorders (4), depression (2), tic disorders (2), attention deficit disorders (2), separation anxiety disorders (1), enuresis (1). 4) On CBCL, the patients with RAP were more internalized, socially less competent and less active compared with the control subjects. 5) According to the parent-environment rating scale, the patients with RAP had more conflicts with their parents about control issues. Family members of the patients with RAP were socially less competent and less abjustable. The parents of the patients with RAP were more affectionate and spent more time with their children but they were unfair and vague on instruction and discipline.

This study intended to investigate the characteristics of adolescent drug user in Korea. A questionnaire on adolescent drug use was administered to 1st or 2nd grade 898 students (465 males, 433 females) from 9 senior high schools in Seoul area. The extent of current using six representative drugs such as cigarettes, alcohol, chemical substance inducing hallucination(e,g., thinner, bond etc.), psychostimulant, hypnotic and minor tranqulizer was self-reported. Also their psychological distress, self-concept and individual-related variables such as academic grade, deviant behavior, drug-using peers, the perceived availability of drugs, the degree of family discipline, and the perceived parents' attitude for drinking and smoking were surveyed. Subjects were grouped into six(male) or five(female) subgroups (nonuser, simple experiencer, one kind of drug user, two kinds of drugs user, three kinds of drugs user(male only), minor tranqulizer user) to their extent of drug use. Then ANOVA procedure performed for group comparison of their psychological distress, self-concept and individual-related variables. The results showed that the most popular drugs among adolescents in Korea were cigarettes and alcohol. Minor tranqulizer was used by about 2.8% of male and 7.41% of female subjects. In general abusers showed lower academic grade, more deviant experiences, having more drug-using peers, higher degree of psychological distress, and lower postitive self-concept than nonuser group. According to the results of discriminant analysis, hostility and deviant behavior were reliable predictive variables that distinguished abuser group from nonuser group among the associated variables in this study. These results suggest that some common factors affect drug use of Korean high school students : high school students who have many common risk factors could be abusers more easily. These findings supported risk factor theory that the extent of drug use of adolescents might be associated with general maladjustment in everyday life.

This paper reports on the development of the Children's Separtion Rating Scale(CSRS), its initial reliability and validity, and clinical/research utility with psychiatrically hospitalized children. The CSRS appears to be a reliable and valid instrument, and useful in distinguishing children's separation reaction from their general psychopathology. It may be also useful in aiding clinicians in differential diagnosis. This study points to the need for further understanding of children's psychiatric hospitalization in relation to their separation reaction and its possible untoward effects. Findings of this pilot study support the notion that inpatient treatment programs should address the developmental needs and abilities of the various age groups and the particular deficits reflected in their psychopathology.

The study was to examine the effectiveness of the educational program for the parents of autistic children in promoting the development and amelioration of psychopathology. Behavioral pathology and developmental function of autistic children of two parent groups, parents who participated in educational program and parents who did not participate in that program, were compared before and after partent education program. For these purpose, the data were collected from 30 subjects(15 for participant group and 15 for non-participant group) who were diagnosed as Autism according to DSM-III at Child-Psychiatry of Seoul National University Hospital during May 16, 1987 through April 30, 1988. Pre and post tests by Schopler's Psycho-Educational Profile scale were performed for all of the subjects and the data were analyzed by Wilcoxon Rank Sum test, Wilcoxon Sign Rank test and The results obtained were as follows ; 1) The autistic children of participant group were significantly higher than those of non-participant group after education on Imitation, Gross motor and Eye-hand Integration scale of developmental function area (p<0.05) 2) After education, the autistic children of participant group were significantly improved in Affect and Language scale of behavioral pathology area (p<0.05). 3) After education, the autistic children of participant group were significantly improved in developmental function, such as perception, Fine motor, Gross motor, Eye-hand Integration, Cognitive Performance, Cognitive Language (p<0.05). 4) The autistic children of non-participant group were significantly improved in Relating behavior and developmental functions such as Perception, Fine motor and Eye-hand Integration at post test in comparison to pre test (p<0.05). From these results, it might be concluded that the autistic children of participant group were improved much more, and obtained higher score in developmental function area than those of non-participant group. It is suggested that this kind of education program helped and supported the parents to do some more appropriate approach for the development of their children.

The reverse of reinforcement technique was used in treating rumination of a 12-year old (estimated age) mentally retarded child in a residential setting. The subject's rumination pattern was first to vomit the food onto the floor and then to eat it back in several attempts. Consequently, the way to reverse the contingency of rumination in this child was to take away the discharge whenever rumination occurred. An ABAB single subject design was adopted to evaluate the treatment effect. In baseline 1 the frequency of his rumination for 2.5 hours after eating was an average of 46(range= 30-62), while decreased to 6.7 in treatment condition 1. However, when the discharge was not taken away in baseline 2, his rumination increased to 34 times and then decreased to zero to 1 time when the reverse of reinforcement was reinstituted in treatment condition 2. The results clearly indicate that the reverse of reinforcement which was implemented in the form of removing the discharge from the floor was successful. It was reported that the treatment effect has been maintained over 10 months post treatment.